Healthcare Provider Details

I. General information

NPI: 1457255739
Provider Name (Legal Business Name): JILLIAN KERUBO MOTURI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 23RD AVE NW
ROCHESTER MN
55901-2125
US

IV. Provider business mailing address

5606 23RD AVE NW
ROCHESTER MN
55901-2125
US

V. Phone/Fax

Practice location:
  • Phone: 507-319-0872
  • Fax:
Mailing address:
  • Phone: 507-319-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14783
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: